CAJ | 학술논문

目的探讨临时性和(或)可转换性下腔静脉滤器取出时的常见问题及解决方法,提高滤器取出率,减少永久性植入带来的不利影响.方法 2007年7月至2012年3月对576例经彩超检查合并有下肢深静脉血栓形成的骨创伤患者于骨科手术前植入临时和(或)可转换型下腔静脉滤器,包括临时性下腔静脉滤器192例,可转换性滤器384例.临时性和(或)可转换性滤器于滤器植入后2～4周数字减影血管造影(digital subtraction angiography,DSA)评估取出. 结果临时性下腔静脉滤器取出率100％,其中经溶栓导管溶栓后取出24例,1例更换永久滤器.7例捕获大血栓但采用吸栓与取滤器同时进行的方法获得成功.15例滤器严重倾斜者采用双圈套器顺利取出.随访率100％,平均随访时间(26±18)个月,无再次发生肺栓塞病例,26例下肢深静脉血栓症状性复发,经抗凝治疗后好转,没有出现有严重并发症的深静脉血栓形成后遗症.结论溶栓导管的应用可以有效去除临时性和(或)可转换性滤器所捕获的血栓,从而提高滤器取出率.双圈套器技术可提高严重倾斜滤器的取出率,减少永久性滤器植入带来的不利影响.
목적 탐토림시성화(혹)가전환성하강정맥려기취출시적상견문제급해결방법,제고려기취출솔,감소영구성식입대래적불리영향.방법 2007년7월지2012년3월대576례경채초검사합병유하지심정맥혈전형성적골창상환자우골과수술전식입림시화(혹)가전환형하강정맥려기,포괄림시성하강정맥려기192례,가전환성려기384례.림시성화(혹)가전환성려기우려기식입후2～4주수자감영혈관조영(digital subtraction angiography,DSA)평고취출. 결과 림시성하강정맥려기취출솔100％,기중경용전도관용전후취출24례,1례경환영구려기.7례포획대혈전단채용흡전여취려기동시진행적방법획득성공.15례려기엄중경사자채용쌍권투기순리취출.수방솔100％,평균수방시간(26±18)개월,무재차발생폐전새병례,26례하지심정맥혈전증상성복발,경항응치료후호전,몰유출현유엄중병발증적심정맥혈전형성후유증.결론 용전도관적응용가이유효거제림시성화(혹)가전환성려기소포획적혈전,종이제고려기취출솔.쌍권투기기술가제고엄중경사려기적취출솔,감소영구성려기식입대래적불리영향.
Objective To study the complications related to and its management after retrieving temporary and retrievable IVC filters.Methods From Jul 2007 to Mar 2012,576 consecutive cases of deep venous thrombosis secondary to bone fractures confirmed by Duplex ultrasonography,received IVCF deployment to avoid fatal pulmonary embolism during perioperative period.There were 192 cases receiving temporary filters and 384 cases with retrievable filters.The temporary and retrievable filters were removed 2 to 4 weeks after implantation.Results The success rate of temporary filter removing was 100％.In 24 cases,the filters captured huge thrombi,and they were removed after thrombolysis using the Uni-fuse catheter.One patient received permanent filter deployment before removing the tempo-filter.Filters were successfully removed in 367 out of 384 cases with retrievable ones with a successful rate of 95.57％.In 7 cases the filters were removed with large thrombi.Double-snare-technique was used to retrieve 15 seriously tilted filters.After a mean 22 months follow-up,no pulmonary embolism occurred,but symptomatic DVT were revealed in 26 patients,and the conditions were improved after anticoagulation treatment.Conclusions The application of Uni-fuse thrombolysis catheter increases the success rate of filters retrieving,double-snare-technique helps retrieve seriously tilted filters and decrease long-term complications of permanent filters.